Pediatrician to Parent

Fight Childhood Obesity - Start at Home

By Dr. Sophie Lung
Pediatrics - The Woodlands

Increased media attention to childhood obesity has led many parents and teenagers to ask me about diet and nutrition. Even First Lady Michelle Obama has started a crusade against childhood obesity.  

Here are eight tips on how to help prevent or manage childhood obesity:

1. Eat breakfast every day. Research shows that teenagers who ate breakfast had healthier weights compared to teenagers who skipped breakfast.
2. Eat a variety of foods. I often tell my patients that a well balanced meal has lots of different colors. The more colors, the better. The recommended amount of servings of each food group and portion sizes will vary depending on your child’s age. Check out mypyramid.gov to find personalized recommendations. 
3. Eat healthy snacks. You can still eat snacks as part of a healthy diet. Substitute fresh fruits and vegetables for junk food. 
4. Encourage healthy drinks. Limit fruit juices and eliminate sodas. Limit juice intake to 4 oz a day for children under 6 years and 8 oz for older children. Soft drinks have no nutritional benefits for your children. Instead, encourage water intake. Milk is also important for calcium requirements. Children between 1 and 2 years of age can drink whole milk, and children over 2 years should drink skim or 2% milk.
5. Limit fast food. If you don’t have time to cook, try to pick healthier options like salad with fat-free dressing or grilled chicken when you go out. When you do have time to cook, make extra and store it in the freezer. Later, you can raid your freezer and still have a healthy home-cooked meal.
6. Turn off the TV. When you eat in front of the TV, you lose track of how much you’re eating. Additionally, time spent in front of the TV is better spent doing something active.
7. Involve the entire family. Making lifestyle changes is not easy. It works better if the entire family has the same goal and all members participate. Furthermore, research has shown that families who eat together have healthier diets.
8. Exercise. Try to exercise 45 minutes to 1 hour every day. Try different activities until you find something your child enjoys. Suggestions include running, biking, swimming, jump roping, hula hooping, and many more. Be creative! Create competitions between family members. The more people who participate, the more fun it will be.

 

 

Good Germs Fight Bad Germs - Probiotic Use in the Pediatrician’s Office

By Dr. Dawn Lord
Pediatrician - Kelsey-Seybold Clinic

Recently, during an onslaught of a stomach bug going around the northwest Houston area, I found myself recommending parents give their children things with names like Lactobacillus reuteri and Bifidobacterium longum, some common probiotic supplements.

Essentially, this amounted to fighting fire with fire, or more accurately, fighting microbe with microbe. Our hope when using probiotics is to shorten the number of days that the child has with the diarrhea that accompanies the stomach virus.

Have you heard about the latest research findings regarding probiotics?

First the definition: A probiotic is a health supplement or a food source that contains enough of a specific group of naturally-occurring, good bacteria to provide health benefits.

Certain types of yeast can be classified as probiotics as well. These microbes have inherent properties that allow them to take up residence in the gastrointestinal system where they can overtake harmful bacterial and possibly manufacture substances that impart a boost to the immune system.

Probiotics have an excellent safety profile in healthy infants and children. However, their safety in those who are seriously or chronically ill has not yet been determined.

During the last year, probiotic supplements and food items have proliferated on grocery and pharmacy shelves. Often, the probiotic preparation has to be refrigerated and is in the dairy section or behind the pharmacy counter. These items do not require a prescription, but their most successful use will undoubtedly be under the supervision of your child’s pediatrician.

Why not ask about them at your next visit?

Effects of Sugar on Children Aren’t so Sweet

By Dr. Felicia Workeneh
Kelsey-Seybold Clinic - Silverlake 

Over the last 50 years, the amount of sugar in the American diet has risen significantly. Table sugar and wide-spread consumption of high-fructose corn syrup, which is found in sweetened beverages, has contributed to the increased rate of chronic diseases in the United States to epidemic levels.  

High-fructose corn syrup contains glucose and fructose, but is distinct from table sugar, which also contains glucose and fructose because it yields a greater percentage of fructose.  

In addition, the fructose in high-fructose corn syrup is more rapidly absorbed into the body, resulting in greater toxicity.  A high amount of fructose is particularly harmful because it has been connected to the development of diabetes, vascular injury resulting in stroke, heart attack and kidney disease.  

Although much focus has been placed on the restriction of fructose, it is critical to limit all sugar to recommended amounts. The American Heart Association recommends that young children should consume no more than 130-170 calories (3-4 teaspoons) of added sugar a day.

As your child grows into his preteen and teen years, the maximum amount of added sugar included in his daily diet should be 5-8 teaspoons.  

A simple and practical way to reduce the amount of sugar in your child consumes would be to reduce or eliminate sweetened beverages from our child's diet.  

You can find other ways to identify healthy choices and limit sugar in your child's diet by visiting: http://mypyramid.gov, or talking to your child's doctor. 

Potty Training: There’s no right or wrong way

By Dr. M. Ryan Kozak
Kelsey-Seybold Clinic - The Woodlands

Often, I am asked by parents what the best age to start toilet training their children. How long does it take to potty train and what’s the best method for teaching them?

Most children are ready to toilet train after about 18 months. This is the age when most children not only have the communication skills (not necessarily “language”) to express their need to go, but also the neurological development needed for conscious control of the processes.

Some tell-tale signs of the child’s readiness include an intense curiosity about what you are doing in the bathroom. They may have a desire to come in with you or express an interest in flushing the toilet. Playing in the water doesn’t count!. Your child may also let you know when it’s time for a diaper change. 

Watch to see if your child has a favorite place to dirty their diaper, which indicates they are able to at least hold it long enough to make it to that location. They may even awaken from short naps with a dry diaper.

Different children train in different periods of time. Most sources agree that two to three months of steady training is fairly standard, although I’ve had parents tell me they trained their daughter in a weekend, while other parents are still struggling after their child is 3 years old. The more time you have available to devote to it, the quicker the training should come along.

Keep in mind that virtually 95 to 99 percent of children are daytime-toilet trained by around 5 or 6 years of age, regardless of what method was used. Most children, like most adults, do not enjoy being wet or soiled if they can help it. This holds true for cultures around the world, even those that don’t use diapers, potty chairs or even toilets.

And what’s the best way to train your child? A popular Internet search engine lists almost 2 million hits when searched for “toilet training.” A website for a popular bookstore chain lists more than 400 books available on the subject. 

Why are there so many? The plain and simple truth is that none of them are wrong.  There are as many professional opinions on how to toilet train your child as there are professionals.

Different methods work for different children. Personally, I prefer using rewards and praise for the child’s accomplishment. A sticker board for each time the potty is used correctly, or a small treat (try and keep it healthy) is great incentive.  Make it fun for the child, and let them color or decorate the potty themselves.

Remember to never punish your child for accidents. This is a learning process that takes time, and feelings of guilt or failure will only be counterproductive.

Consult your pediatrician if you have devoted more than three solid months to training without success, your child is more than 3 years old and has not begun to train or if you feel you are starting to get into a “battle of wills,” as one parent put it.

Also, be aware that discomfort to the point of pain is not a normal part of training. Visit your doctor if your child complains of pain while urinating or passing a bowel movement, as this could indicate a urinary tract infection or constipation.

Make Eating Fun for Your Picky Eater

By Candace Siegel, M.D.
Kelsey-Seybold Clinic – Clear Lake

As a parent, I can appreciate the frustration of sitting at the dinner table and watching my child only eating chicken nuggets and French fries, completely avoiding any fruits and vegetables.

As a pediatrician, I recommend four to five servings of fruits and vegetables a day, but in reality, you will be lucky if your child eats that many servings in a week. I absolutely discourage force feeding children, but there are some techniques you can do to encourage more balanced meals.

Get Creative
It’s important to understand that children’s taste buds change over time, and the food they refuse today, may be a favorite tomorrow. Try to offer a variety of foods and present them in different ways to appear more inviting.

Try cutting fruits and vegetables into interesting shapes, or offer a dipping sauce such as cheese, peanut butter, yogurt or ketchup. In addition, put only small amount of food on the plate (using a kid-friendly dish or bowl sometimes helps).

It is okay to sneak chopped vegetables and fruits into foods, such as into the spaghetti sauce. Kids are reluctant to try new foods, and actually need to see a new food 10 to 15 times before they will try it. It is worthwhile to keep putting new food on their plate until eventually, they become brave enough to try a bite.

Breakfast for Dinner
In addition, if your child is not hungry at mealtimes, you can offer the meal later as a snack. Alternatively, you can sometimes have “upside down meals,” with breakfast food for dinner or vice versa. Try to limit dessert to two times a week, but on occasion, just for fun, have a “backwards dinner” with dessert first.

Set an Example
It is important to set a good example at mealtime – your child will be more likely to try to eat what you are eating. I encourage the whole family to sit down together for at least one meal a day and to make it a fun time. Try to avoid a power struggle with your child over what he is not eating.

Your child may be more likely to try new foods if they can help in the food selection process or preparation. Starting a garden might be fun, or shopping together at a farmers’ market. There are several kids’ cookbooks available that might make food preparation more enjoyable, as well as websites, such as www.PlayingKitchen.com, with ideas for cooking with kids.

One last suggestion: try to avoid sugary drinks between meals, such as juice, Kool-aid or sodas, as these drinks tend to fill up little stomachs and they are less likely to eat more nutritious food.

On coughs, colds and such

By Dr. Anjana Dhingra
Kelsey-Seybold Clinic - Fort Bend  

’ Tis the season for family get-togethers… and also for children to get runny noses, coughs and fevers! Most of these symptoms are caused by upper respiratory infections – also called URIs – or simply a ‘head cold.’

These are usually self-limiting illnesses, lasting one to two weeks, and don’t require any antibiotics. Cold symptoms include: 

• Fever - may last as long as four to five days
• Nasal congestion - (three to seven days)
• Cough - (three to seven days)

Improvement in these symptoms is generally noted by the second week. If not, it is time to take your child to their pediatrician. Other reasons you should take your child to their doctor include: 

• Ear pain
• A fever greater than 101 degrees for more than four days
• Breathing difficulty, wheezing or excessive cough

Extreme fussiness and irritability (even after fever has come down with fever reducing medication), may be a good reason to be seen urgently as this may imply a serious illness.

The management goals of the pediatrician and parent are to help the symptoms, providing comfort as the infection runs its course. So get plenty of rest and drink plenty of warm fluids for a speedy recovery.

Why is rest necessary? The body needs extra energy to heal itself. If the energy is used in outward activities, less is available internally to fight the infection. This will delay the recovery process. 

Drinking warm fluids provides warmth (energy) and hydration allows the body to get rid of unwanted byproducts of the body while fighting the infection. 

Remember your child’s immune system is the best medicine you have available to help you heal from an upper respiratory infection!

Know the Warning Signs of Childhood Cancer

By Dr. David Barry
Kelsey-Seybold - Humble Clinic

I recently saw a 3-year-old girl who had been feeling fine until one evening, she complained to her mother that her tummy hurt. Her mom put her hand on her abdomen where she felt a mass and brought her to our Humble Clinic. The mass turned out to be a tumor in the kidney, called a Wilm’s tumor, which is curable with surgery.

A year and a half ago, I treated a 6-year-old boy with puffy eyes and a sinus infection for allergies and sinusitis. A month later, when he developed breathing difficulty, an X-ray revealed that he had a mass in his chest partially obstructing the blood flow from his face. 

The mass was pressing on the large vein from his upper body and a blood count pointed toward leukemia. Thankfully, he has since gone into remission with chemotherapy. 

A pediatrician will rarely see a child with an undiagnosed cancer – it happens maybe once every two or three years. Usually, the signs and symptoms are not red flags like an abdominal mass, but are attributed to a more common ailment such as bone pain or trauma in a teenager. 

The Seven Warning Signs of Cancer (will link), made famous by the American Cancer Society in the 1950s, apply to adults only. The M D Anderson Cancer Center has made a list of the most common signs and symptoms of cancer in children. They include: 

• Abdominal mass
• Persistent enlargement of the lymph nodes
• Pallor or bleeding
• Neurological deficits (such as suddenly crossed eyes)
• Increased intra-cranial pressure (headaches, vomiting)
• A white pupil
• One-sided knee or shoulder pain or swelling
• And vaginal bleeding or mass

Most childhood cancers are now curable if detected early. Parents can contribute greatly to early detection by being aware of these signs and asking their pediatrician about the possibility of cancer if their child is not improving with treatment.

The Daycare Blues

By Dr. Felicia Workeneh
Kelsey-Seybold Clinic – Silverlake 

When considering daycare options, many parents are apprehensive about the possibility that their child will contract frequent illnesses, such as colds.

Parents understandably place their focus on how “clean” the daycare is and tend to associate a tidy outward appearance with decreased odds of illness.

Even if a childcare center does everything in their power to keep their facility clean, it is inevitable that when you place your child in a classroom full of children, colds and other infections are bound to be passed around. 

Children in daycare contract, on average, 12 colds per year. And if you factor in the time it takes to get over a cold – typically one to two weeks – the parents get the impression that their child is sick year round.  
With this in mind, what should you be looking for in a daycare center?  

Ask to view the daycare’s policy and procedures regarding handling of sick children who are in their care.   
Make sure the daycare teaches and promotes good hand washing after using the bathroom and before eating. Since small children often have difficulty washing their hands completely, check to see if sanitizing lotion is available for them.

Look for a daycare with smaller numbers of students in each classroom and largely spaced classrooms. This allows for fewer numbers of kids to transmit germs to one another and for the children to space themselves so they are less likely to pass germs easily. 

Be conscientious of other children when your child is sick. Find alternative care for your child to prevent them from spreading germs to others.   

Keeping these tips in mind should help reduce the frequency of illness in your little one. Happy daycare hunting!